A Single Capability within Your PHM Platform Can Make—or Break—Your Organization

Value-based care has totally changed the model of healthcare reimbursements. Providers are incentivized for the value of the care they deliver rather than the volume of services they offer. So, to help enhance quality of care, provider entities are looking to advanced Clinical Performance Dashboards as the ultimate tool because of their actionable intelligence.

But in saying that, what does actionable intelligence really mean to the user? What does it matter if someone says their platform has actionable intelligence, especially if those capabilities are minimal? Well…it matters so much we’re willing to dedicate an entire blog to it.

If you want to meet patient compliance, have appropriate emergency department utilization, and to prevent 30-day readmissions, you need to make sure your population health management (PHM) platform has excellent actionable intelligence capabilities in its Clinical Performance Dashboards. And that’s just the beginning of the story. You may not realize it, but the power of actionable intelligence is so huge, it can make or break your organization. So, to make sure you don’t just survive—but that you thrive—in the healthcare industry, let’s dig into the heart of this key PHM function. To better illustrate the capabilities of Clinical Performance Dashboards, I’ll use “John” and his role as a Quality Director in an ACO setup.

John is a Quality Director in a large ACO which is tied up with 3500 providers. He is responsible for the overall quality of the members under all the providers mapped under him. Because the incentives are tied with quality measures, John is focused more on how the providers are performing on HEDIS/STAR/ACO measures that are part of the value based contracts. He’s interested in viewing the performance of the patient population for which he is responsible and doesn’t want to wait until the end of the year to find out how his provider entities did—based on the incentives they receive. Instead, he wants to measure the performance of provider entities on a continuous basis throughout the year so that he can enable provider entities improving the performance before the end of the year. Without Clinical Performance Management Dashboards, John must pull the overall patient population list by querying the data base. If he wants to filter the patient population with respect to any attributes such as age group, provider location, specialty, or the clinical quality measure itself, he needs to filter them by fine tuning the query. This not only requires technical capabilities, but it can also become an overhead for John. Clinical Performance Management Dashboards are designed to help people like John to monitor and manage the quality of patient care.

John can use the Clinical Performance Dashboards to quickly identify non-compliant providers for each clinical quality measure, the best performing provider for each clinical quality measure, and even go on to identify the non-compliant patient population of an individual provider. John could make use of the different levels of the Clinical Performance Management dashboards to manage the quality of the patient population and can associate actionable intelligence capabilities to close the patient non-compliances.

Following are such actionable features that can help in closing the patient non-compliance:

  • Initiate a correspondence to the non-compliant member so that the member is notified about the non-compliance. Then, the member can perform the required actions to close the non-compliance.
  • Create an activity for the non-compliant member. The care manager or the nurse of the member can review the member activities and work toward closing those non-compliances.
  • Place a call to the member and perform follow-up actions as to close member non-compliance.
  • Add an assessment that provides additional health or clinical information about the non-compliant member. The information will enable the user to address member non-compliance.

Using the actionable intelligence inside Clinical Performance Management dashboards, John can truly influence change by improving the quality of the ACO patient population. He can manage the patient population throughout the year on a continuous basis with the help of sophisticated analytics and actionable intelligence associated with the Clinical Performance Dashboard. John is on his way to enhancing his care management and improving the lives he touches.

So, there it is. Actionable intelligence: two words in the PHM world that totally deserve all the attention they receive. With the sophisticated analytics and actionable intelligence working hard within the Clinical Performance Dashboards, everyone’s life is a lot healthier. And that’s the whole point, right?


DKThiyagarajan

Dineshkumar Thiyagarajan works as an Associate Product Manager in the Product Planning-EDW Analytics & Performance Management department. He is a certified Product Owner and brings about 9 years of diverse experience in Business Analysis, Market Analysis, and Agile Methodologies across Healthcare, Converged Infrastructure, and Banking domains. He has previously worked as a Product Owner with EMC Corporation, Bangalore and Wipro Technologies, Bangalore. He holds a Bachelor of Engineering degree in Electronics and Communication from Anna University, Chennai and an MBA degree in Marketing and Strategy from Glasgow Caledonian University, United Kingdom.